Compare Pike County Georgia
Medicare Advantage Plans

A Medicare Advantage Plan in Pike County, GA can provide additional benefits above and beyond Original Medicare. There are 43 Medicare Advantage Plans (Part-C) available in Pike County from 8 different health insurance providers to compare in 2023. 19 of these Medicare Advantage Plans offer additional gap coverage to help avoid the “donut hole”. The plan with the lowest out-of-pocket expense is $2900 and the highest out-of-pocket is $8300. Pike County Georgia qualifying beneficiaries can also pick from 18 Medicare Special Needs Plans. The highest rated Medicare Advantage Plan in Pike County Georgia received a 4.5 overall star rating from CMS.



Most Popular Plans by Enrollment in Pike County, Georgia

Plan Name Plan ID Marketing Name Monthly
Premium
Enrollment
HumanaChoice H5216-203 (PPO)
H5216-203
Humana $0 51258
UnitedHealthcare Medicare Advantage Choice Plan 1 (PPO)
H6528-006
UnitedHealthcare $0 29604
UnitedHealthcare Medicare Advantage Choice (Regional PPO)
R2604-001
UnitedHealthcare $49.00 27701
HumanaChoice H5216-280 (PPO)
H5216-280
Humana $36.70 26471
Wellcare No Premium (HMO)
H1112-038
Wellcare $0 12931


2023 Medicare Advantage Plans in Pike County, GA

(Click the Plan Name for More Details)
(⇅ Click the Header to Sort)


Name ⇅ Monthly
Premium
Deductible MOOP Gap 2023 Plan
Stars
Rating
Wellcare Premium Enhanced Open (PPO)
(H0111-003)

$85.00 $75.00 $6,000 Yes
Wellcare No Premium Open (PPO)
(H0111-001)

$0 $75.00 $5,500 Yes
Wellcare No Premium (HMO)
(H1112-038)

$0 $0 $8,300 Yes
Wellcare Low Premium Open (PPO)
(H0111-002)

$55.00 $150.00 $6,700 Yes
Wellcare Giveback (HMO)
(H1112-042)

$0 $480.00 $8,300 No
Wellcare Assist (HMO)
(H1112-043)

$28.10 $475.00 $3,650 No
UnitedHealthcare Medicare Advantage Choice Plan 1 (PPO)
(H6528-006)

$0 $275.00 $6,700 Yes
UnitedHealthcare Medicare Advantage Choice (Regional PPO)
(R2604-001)

$49.00 $295.00 $6,700 Yes
HumanaChoice R3392-004 (Regional PPO)

$0 $195.00 $7,550 No
HumanaChoice R3392-002 (Regional PPO)

$103.00 $340.00 $6,700 No
HumanaChoice H5525-024 (PPO)

$45.00 $295.00 $6,700 No
HumanaChoice H5216-345 (PPO)

$0 $0 $7,550 Yes
HumanaChoice H5216-280 (PPO)

$36.70 $505.00 $7,550 Yes
HumanaChoice H5216-279 (PPO)

$0 $0 $2,900 Yes
HumanaChoice H5216-203 (PPO)

$0 $0 $7,550 Yes
HumanaChoice H5216-154 (PPO)

$0 $400.00 $7,550 No
Humana Gold Plus H4141-017 (HMO)

$0 $0 $7,550 Yes
Clover Health LiveHealthy Value (PPO)
(H5141-045)

$37.30 $395.00 $6,600 No
Clover Health LiveHealthy (PPO)
(H5141-026)

$0 $0 $7,550 No
Clear Spring Health Select Plus (HMO)
(H6672-005)

$0 $0 $3,450 NoNA
Clear Spring Health Choice Plan (PPO)
(H9589-003)

$0 $250.00 $6,700 NoNA
Anthem MediBlue Plus (HMO)
(H5422-011)

$0 $0 $7,100 Yes
Anthem MediBlue Extra (HMO)
(H5422-013)

$24.50 $505.00 $5,900 No
Anthem MediBlue Essential (HMO)
(H5422-008)

$38.00 $0 $3,450 Yes
Anthem MediBlue Access Basic (PPO)
(H7728-006)

$0 $0 $6,700 Yes
Anthem MediBlue Access (PPO)
(H7728-005)

$59.00 $0 $6,050 Yes
Aetna Medicare Value Plus Plan (PPO)
(H2293-001)

$28.00 $505.00 $8,300 NoToo New
Aetna Medicare Preferred Premium Plan (PPO)
(H3288-042)

$32.00 $150.00 $8,300 Yes
Aetna Medicare Freedom Plus Plan (PPO)
(H2293-008)

$0 $0 $5,500 YesToo New
Aetna Medicare Freedom Plan (PPO)
(H3288-026)

$0 $150.00 $6,900 Yes
AARP Medicare Advantage Choice Rebate (PPO)
(H6528-041)

$0 $395.00 $7,550 Yes






Georgia Part-C Plans Without Drug Coverage





Medicare Special Needs Plans in Pike County Georgia

Plan Name ⇅ Monthly
Premium
Part D
Deductible
 Gap  Special
Needs
Type
2023 Plan
Stars
Rating
Wellcare Dual Liberty (HMO D-SNP)
(H1112-033)
   $36.00 $505.00  No Dual-Eligible
Wellcare Dual Access Open (PPO D-SNP)
(H0111-004)
   $37.30 $505.00  No Dual-Eligible
Wellcare Dual Access (HMO D-SNP)
(H1112-006)
   $37.20 $505.00  No Dual-Eligible
UnitedHealthcare Medicare Silver (Regional PPO C-SNP)
(R2604-002)
   $9.50 $505.00  No Chronic or Disabling Condition
UnitedHealthcare Medicare Gold (Regional PPO C-SNP)
(R2604-003)
   $15.00 $0  Yes Chronic or Disabling Condition
UnitedHealthcare Dual Complete Choice Select LP (PPO D-SN
(H3256-002)
   $32.30 $505.00  No Dual-Eligible
UnitedHealthcare Dual Complete Choice LP (PPO D-SNP)
(H3256-001)
   $37.30 $505.00  No Dual-Eligible
UnitedHealthcare Dual Complete (HMO-POS D-SNP)
(H5322-030)
   $35.90 $505.00  No Dual-Eligible
HumanaChoice SNP-DE H5216-206 (PPO D-SNP)
(H5216-206)
   $37.30 $505.00  No Dual-Eligible
HumanaChoice SNP-DE H5216-205 (PPO D-SNP)
(H5216-205)
   $37.30 $505.00  No Dual-Eligible
HumanaChoice - Diabetes and Heart (PPO C-SNP)
(H5216-246)
   $0 $145.00  Yes Chronic or Disabling Condition
Humana Together in Health (PPO I-SNP)
(H5216-242)
   $34.80 $505.00  No Institutional
Humana Gold Plus SNP-DE H4141-003 (HMO D-SNP)
(H4141-003)
   $37.30 $505.00  No Dual-Eligible
Clear Spring Health Silver Plan (HMO C-SNP)
(H6672-003)
   $0 $250.00  No Chronic or Disabling ConditionNA
Clear Spring Health Deluxe Plan (HMO D-SNP)
(H6672-001)
   $37.30 $505.00  No Dual-EligibleNA
Anthem MediBlue Enhanced Care (HMO D-SNP)
(H5422-018)
   $17.20 $505.00  No Dual-Eligible
Anthem MediBlue Dual Advantage (HMO D-SNP)
(H5422-007)
   $37.30 $505.00  No Dual-Eligible
Anthem MediBlue Dual Access (PPO D-SNP)
(H7728-011)
   $37.30 $440.00  No Dual-Eligible



Types of MA Plan in GA


HMO - Health Maintenance Organization. A Health Maintenance Organization manages your Part A and Part B health insurance benefits. In most cases you need to choose a primary care doctor. Health Maintenance Organization's offers services through a network of contracted hospitals, doctors and other providers, and the plan pays the providers directly. You generally must receive all Healthcare from the plan providers or through referrals from the plan provider. Emergency care, and out-of-area urgent care is still covered. An HMO-POS plan allows you to get some services out-of-network.

PPO - Preferred Provider Organization. A Preferred Provider Organization offers a network of doctors, hospitals, and other providers you can choose from. Because providers are preferred, you can save money by using in network providers or usually pay a higher cost to use out-of-network providers. A primary care doctor is not required.

PFFS - Private Fee For Service. A Private Fee For Service plan allows you greater flexibility in choosing a Georgia provider. You may obtain covered services from any Medicare eligible provider who is willing to accept the plan's terms. The Healthcare provider must agree to accept the plan's terms before each visit. Some of these plans have a network of approved providers that have agreed to treat plan members.

SNP - Special Needs Plan. A Special Needs Plan is for individuals who receive Medicare and Medicaid, have specific severe or disabling chronic conditions or reside in a licensed nursing home or skilled facility. SNP plans must provide prescription drug coverage to Pike County Georgia residents.

Cost - Cost Plan. A cost plan doesn't replace your Original Medicare. It offers additional benefits to Original Medicare. If the cost plan doesn't include prescription drug coverage, you can enroll in a Part-D plan separately.





Can I get help in the coverage gap in Pike County, GA?


Yes. 19 Medicare Advantage Plans in Pike County offer additional gap coverage. Once in the coverage gap, you’ll pay no more than 25% of the cost for brand-name and generic prescription drugs. If you choose a drug plan that includes coverage in the gap, you may get a discount applied to the drug's price.

Are there Medicare Advantage Plans in Pike County, GA?


There are 43 Medicare Advantage Plans available in Pike County, Georgia from 8 different health insurance providers. These plans offer additional benefits that aren't available through Original Medicare. Medicare beneficiaries who are interested in a Part-C policy may choose among many plans to compare versus Polk County Medicare Advantage Plans.



How much is a Medicare Plan in Pike County, GA?


Individuals who are interested in a Medicare Advantage Plan in Georgia may choose among many cost options depending on your necessary benefits. The lowest plan premium is $0 and the highest premium is $103. The deductibles in Pike County range from $0-$505. The plan with the lowest out-of-pocket (MOOP) expense is $2900 and the highest out-of-pocket is $8300.



Things to consider when choosing a MA Plan in Pike


  • Are you eligible for a Medicare Advantage Plan?

  • How much are the premiums, deductibles, and other costs?

  • Is there a yearly limit on what you could pay out-of-pocket?

  • Does the plan cover your prescription drugs?

  • Will you hit the prescription drug coverage gap?

  • Is your pharmacy in the plan’s network?

  • Will your prescription drugs require prior authorization?

  • How well does the plan cover the services you need like vision, hearing, or dental?

  • Are your doctors in-network?

  • Will you need to be referred to see a specialist?

  • Does the plan cover services from out-of-network providers?

  • How does the plan compare to your current coverage?

  • Do you want to juggle multiple Medicare plans?


Special Needs Plan in Pike County Explained


C-SNP - Chronic Condition SNP. These plans help individuals receive customized care to fit their unique health care needs. You may qualify for C-SNP if you have one or more specific severe or disabling chronic conditions like:

  • Stroke
  • Certain neurologic disorders
  • Certain chronic and disabling mental health conditions
  • HIV/AIDS
  • Certain chronic lung disorders
  • Diabetes mellitus
  • End-Stage Renal Disease (ESRD)
  • End-stage liver disease
  • Certain severe hematologic disorders
  • Chronic alcohol and other drug dependence
  • Certain cardiovascular disorders
  • Cancer
  • Chronic heart failure
  • Certain autoimmune disorders
  • Dementia

I-SNP - Institutional SNP. These plans require 90 days or longer stay in a facility, or are expected to need the level of services provided in a long-term care (LTC) skilled nursing facility (SNF), a LTC nursing facility (NF), an intermediate care facility for individuals with intellectual disabilities, or an inpatient psychiatric facility.

D-SNP - Dual Eligible SNP. Georgia Medicare and Medicaid enrollees who have limited income and resources may get help paying for their premiums and out-of-pocket medical expenses from Medicaid. Eligibility is based on a percentage of Federal Poverty Levels.


When to sign up for a Georgia Medicare Advantage Plan?


Below mentioned are the types of the enrollment period, along with the instructions on what to do during this period:

Initial Enrollment Period (IEP). This period starts 3 months prior to the month you will turn 65. It ends after 3 months you have turned 65. At this stage, you can sign up for a Georgia Medicare Advantage Plan.

Annual Enrollment Period (AEP). Also known as the Open Enrollment Period, it starts on the 15th of October and ends on the 7th of December. At this stage, you can either sign up for the plan, switch or leave your current plan.

Special Enrollment Period (SEP). This enrollment period depends on the personal circumstances of the beneficiaries, like if you move or lose insurance coverage. Check to determine if you qualify to modify your plan.

Open Enrollment Period. Jan 1 – Mar 31. If you’re enrolled in a Georgia Medicare Advantage Plan, you can switch to a different Medicare Part-C Plan in Pike County, GA or switch to Original Medicare once during this time.

5-star Special Enrollment Period. Dec 8 - Nov 30. If a Centers for Medicare and Medicaid Services (CMS) 5-star plan is available in your area you can switch to the 5-star plan once during this period.



Check for CMS Star Ratings

Centers for Medicare & Medicaid Service (CMS) assesses the quality of medical services of Medicare Advantage Plan using a 5-star rating system. A report is released yearly for the public to assess the quality of healthcare services. Thus, if you are searching for the highest Medicare Advantage Plan in your state, research the CMS ratings and costs of the plans report for further information.


Can I get a Medicare Advantage Plans in Pike County, GA?

Yes. There are 43 Medicare Advantage Plans available in Pike County, Georgia from 8 different health insurance providers. These plans offer additional benefits that aren't available through Original Medicare.

How much is a Medicare Plan in Pike County, Georgia?

Georgia residents who are interested in a Medicare Advantage Plan may choose among many cost options depending on your necessary benefits. The lowest plan premium is $0 and the highest premium is $103. The deductibles in Pike County range from $0-$505

Can I get help in the coverage gap in Pike County, GA?

Yes. 19 Medicare Advantage Plans in Pike County offer additional gap coverage. Once in the coverage gap, you’ll pay no more than 25% of the cost for brand-name and generic prescription drugs. If you choose a drug plan that includes coverage in the gap, you may get a discount applied to the drug's price.

What is the most popular plan in Pike, GA?

The most popular plan by enrollment in Pike is the HumanaChoice H5216-203 (PPO) with 51258 enrollment.



Source: CMS. Data as of Oct 1, 2022.
Plans are subject to change as contracts are finalized.
Includes 2023 approved contracts. Employer sponsored 800 series and plans under sanction are excluded. For 2023, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit.


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Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options. Enrollment depends on the plan’s contract renewal.

Every year, Medicare evaluates plans based on a 5-star rating system.